What should you know about both big toes bruised under nail?

Blood trapped under a nail is called a subungual haematoma. Repeated pressure from tight or short footwear, running downhill, dancing, or a recent blow can injure small vessels beneath the nail. When both big toes are affected, footwear and activity are useful clues, although a clinician may also check for an underlying nail or skin problem.

The colour may be red, purple, brown, or black and should gradually move toward the tip as the nail grows. A bruise does not always cause dramatic pain, but pressure under the nail can be tender. A dark mark that does not grow out, changes without injury, or affects only one part of the nail needs examination.

Wear roomy shoes with enough space above the toes and pause the activity that caused repeated impact. Keep nails trimmed straight across without cutting into the corners. Protect the toes from further knocks, and use a wrapped cold pack briefly after a recent injury if it is comfortable. Do not drill, pierce, or drain the nail yourself.

Arrange a review if pain is strong, the nail is lifting, walking is difficult, or the injury may include a broken toe. Photographing the nails and noting footwear or exercise changes can help the clinician compare the colour as it grows out.

Seek prompt care for increasing pain, marked swelling, numbness, an open wound, pus, spreading redness, fever, or a toe that looks deformed or feels cold. A clinician should assess persistent or unexplained dark nail colour, especially when the mark does not move outward with nail growth. People with diabetes, poor circulation, or reduced sensation should seek advice sooner after foot injuries.

Does this look like a pressure bruise or another cause of nail discolouration? Is there a fracture or nail-bed injury? Should the blood be released, or is observation safer? What footwear changes will reduce pressure, and how will we monitor the nail as it grows?